右美托咪定预防骨科脊柱手术患者全麻后寒战的临床观察

Dexmedetomidine prevent postoperative shivering in patients undergoing spinal surgery

目的观察右美托咪定对骨科脊柱手术患者全麻后寒战的预防作用。方法全麻下行脊柱手术的患者90例,随机均分为右美托咪定组(D组)和对照组(C组)。D组麻醉诱导后泵注右美托咪定(负荷剂量0.5μg/kg,10min泵完,以0.4μg·kg-1·h-1维持);C组泵注生理盐水,泵注速度及方法同D组。监测并记录诱导前(基础值)、插管后5、15、30、60min及拔管前后HR、MAP、SpO2、肛温(T),观察并记录术后入麻醉后恢复室(PACU)即刻、30、60min VAS评分、Ramsay镇静评分(RSS);记录寒战分级、寒战出现的时间。结果与基础值及与C组比较,插管后30、60min、拔管前和拔管后D组HR明显减慢(P<0.05);拔管前、拔管后D组MAP明显降低(P<0.01)。与基础值比较,插管后30、60min和拔管前、拔管后两组患者T降低(P<0.05)。D组术后寒战发生率明显降低(P<0.01);入PACU后即刻、30min D组VAS评分明显降低(P<0.05或P<0.01);入PACU后即刻、30、60min D组RSS评分明显升高(P<0.01)。结论术中泵注右美托咪定可有效预防骨科脊柱手术患者全麻后寒战的发生。

Objective To observe the effect of dexraedetomidine on preventing shivering in patients under general anesthesia after spinal surgery. Methods Ninety patients scheduled for spinal surgery were assigned randomly into two groups. After endotracheal intubation group D received dexmedetomidine as a preloading dose of 0. 5 /μg/kg in 10 rain followed by a maintaining infusion of 0.4/μg. kg-1. h-1, while group C received normal saline infusion. HR, MAP, SpO2 and rectal temperature（T） were continually monitored during operation. In the post-anesthesia care unit （PACU）, the occurrence times and grades of shivering were recorded. Pain evaluation was assessed by a visual analogue scale; sedation was evaluated by the Ramsay sedation scale as well. Results HR in group D was lower than that at baseline and group C after intubation 30, 60 min and during extubation, after extubation（P〈0. 01）. MAP was lower in group D than that at baseline and group C during extubation and after extuhation（P〈0. 05）. The temperature after extubation was lower than that in both groups after intubation 30, 60min and during extubation, after extubation（P〈0. 05）. The shivering rate in group D was lower than that in group C, while the shivering scores were better （P〈0. 01）. Pain scores were higher in group C （P〈0. 05） and the ramsay sedation scores were higher in group D when compared with another group （P〈0. 05）. Conclusion Intraoperative dexmedetomidine infusion may be effective in preventing postanesthetic shivering.